Healthcare Provider Details

I. General information

NPI: 1750869574
Provider Name (Legal Business Name): JOHN ANTHONY ESCOBAR JR. RRT, SDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE # MOB7
FONTANA CA
92335-6720
US

IV. Provider business mailing address

14712 NOVA SCOTIA DR
FONTANA CA
92336-0618
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-2354
  • Fax:
Mailing address:
  • Phone: 909-587-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number33652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: